Expressive Aphasia: Reporting a Phonological Retrieval Hypothesis for Auditory Verbal Memory Deficits

Journal of Neurology & Stroke

Abstract Case Report

Studies have pointed to a possible close relationship between language deficits and impairment in verbal auditory memory in aphasia. Additionally, there is evidence that aphasics who have predominantly semantic deficits have greater Volume 7 Issue 3 - 2017 impairment in immediate word recall tasks. These studies may contribute for an understanding of the role of auditory verbal memory in language processing. They 1Programa de Reabilitação em Linguagem e Cognição may also shed light into the nature of verbal memory deficits, showing whether (RELINC, CIPAS), Universidade Federal do Rio Grande do Sul, or not they are predominantly semantic or phonological. In the present case Brazil report, we present the word recall performances of two chronic predominantly 2Departamento de Saúde e Comunicação Humana, expressive aphasic cases, one with more phonological than semantic deficits and Universidade Federal do Rio Grande do Sul, Brazil the other with exclusively phonological deficits. The language profile of these patients show relatively preserved semantic processing and predominance *Corresponding author: Lenisa Brandão, Professor of of lexical retrieval and phonological disorders. The results are discussed in Instituto de Psicologia - Universidade Federal do Rio Grande terms of pointing for the role of verbal memory in the access to phonological the Departament of Health and Human Communication, representations. Additionally, the report draws attention for considering data from late recall and word recognition skills, as well as working memory skills in do Sul, Rua Ramiro Barcelos, 2600, Bairro Santa Cecília, aphasia. These findings allow the consideration of the role that executive retrieval Porto Alegre - RS – Brazil, CEP: 90035-003; Tel: (55)(51) skills may play in the access to phonological representations of words. Received:991865323; Email: | Published:

Keywords: Aphasia; Working memory; Word recall; Language; Processing June 26, 2017 August 23, 2017

Abbreviations: ID: Working Memory Inverse Digit Ordering storage devices, they do not consider working memory or auditory Span Task; WS: Working Memory Word and Sentence Span short-term memory as components of language processing. On the Task; IR: Verbal Memory Immediate Word Recall task; LR: other hand, memory models also consider the storage of linguistic Verbal Memory Late Word Recall task; R: Verbal memory Word information and do not take into account the storage devices Recognition task described in language processing models. The classical working memory model [4] includes a phonological loop that would store Introduction numbers and words while performing tasks. According to this model, lists of items would be temporarily stored in auditory- The nature of the relationship between language, working verbal memory via a phonological code. This idea is supported by memory and auditory-verbal memory seems to remain unclear studies with typical speakers, which demonstrate phonological and classical language and memory models appear to view these similarity and word size effects [5]. skills as completely separate modules. Language processing models consider the existence of devices or buffers which store According to Martin et al. [6], explanations about the process of linguistic information. Levelt [1] describes a short-term memory temporary linguistic activation would encompass the functioning device called the articulatory buffer in which a phonetic plan is of auditory-verbal memory. Therefore, the ability to store temporarily stored to be articulated. Nickels [2] also describes words temporarily, that is, auditory-verbal memory, would be a the auditory processing of words with a model that contains property of language processing, that is, auditory-verbal memory phonological input and output buffers, as well as phonological input capacity would be required in language processing. This idea is and output lexicons. Dell’s interactive activation model for word retrieval postulates that lexical retrieval requires a stage of lexical neurological lesions, markedly aphasic patients [5]. access and a phonological stage. In the lexical stage, the semantic consistent with evidences of overlapping deficits in patients with concepts would activate corresponding lexical representations Aphasia is a language disorder caused by injury to brain and, in the phonological stage, the lexical representations would regions important to language processing, being characterized send activation to phonological representations, then the sounds corresponding to the lexical item would be selected. Failures of cognitive functions well known as linguistic are impaired in by expressive and or comprehensive deficits. However, not only activation between these interactive stages would explain lexical aphasia. Several cognitive abilities, such as memory, may be affected in this population [7]. In addition, increasing evidence shows that many cognitive components are recruited and used in andAlthough phonological language difficulties models [3]. suggest the existence of linguistic varying extents during the communication process [8].

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A recent review of the literature [5] shows that aphasic patients in immediate and late word recall subtests. She recovers well with cues in the word recognition task and shows preserved attention, perception, semantic and visual memory skills. impairmentseem to present in verbal a severe auditory difficulty memory. in word Traditionally, recall tasks. aphasics This haveconfirms lower a veryimmediate close relationship word spans betweenwhen compared language to deficits individuals and Case B with left hemisphere lesions who do not present aphasia and This participant is a male, aged 61 years old, with 11 years when compared to individuals with right hemisphere lesions. Thus, verbal auditory memory capacity measured by immediate recall is reduced not only because of slower auditory processing of formal study, and right-hand dominance. He had an ischemic caused by a brain injury, but because word recall is possibly a skill stroke 3 years before he undertook this evaluation and started which takes part in language processing areas affected in aphasia namingtreatment. task The as difficulties well as a presentedgreat number by this of patientanomia demonstrate episodes in severe deficits in word retrieval, with low scores in the Boston words and sentences, as well as in understanding words and [9]. spontaneous discourse. He also has a mild deficit in repeating auditory memory reduction in aphasics investigate the auditory Studies that seek to go beyond the identification of verbal sentences. His spontaneous discourse is marked by the severity memory deficits that appear in this population and compare episodesof anomia of andsemantic apraxia or symtoms.phonemic Hesitations,paraphasia are as observed well as sylable in the and word repetition qualify his discourse as very disfluent. No predominantlythese deficits withsemantic the typesor phonological of linguistic may deficits help observedunderstand in discourse context, neither do they appear in formal testing. Some theaphasia. nature Identifying of the whetherrelationship the linguisticbetween deficits verbal ofmemory aphasics and are language processing [5]. Until now, evidence shown points to the memory,morphemic immediate paraphasia and typicallate word of recallagrammatism subtests iswhen observed. compared His neuropsychological profile shows even lower scores in working greater impairments in immediate word recall tasks. According idea that aphasics who have predominantly semantic deficits have to Case A. In the word recognition task, he also recovers well would have a semantic nature. attention, perception, semantic and visual memory skills. Figure 1 with these findings, auditory verbal memory deficits in aphasia with the word cues. Similar to Case A, he also shows preserved In the present case report, we focus on word recall and working Neuropsychological functions were tested with the Neupsilin-Af, memory performances of two chronic predominantly expressive anshows instrument a summary that of is the adapted neuropsychological for the cognitive profiles testing of bothexpressive cases. aphasics. aphasic cases, one with lexical retrieval deficits characterized As shown in the graphics above, both cases have verbal and recall,mostly weby difficultiesinclude data in thefrom phonological late recall, levelword and recognition, the other withand workingexclusively memory phonological tasks in deficits. order toIn consideraddition theto immediate hypothesis word that cues in the recognition task, which shows that their impairment is predominantlyworking memory in thedeficits. retrieval In addition, of words both and benefited not in their from storage. word memory.deficits in the recovery of phonological representations of words may be influenced by an executive retrieval component of verbal showsCase A severehas a betterimpairment, performance with no in recollection working memory of words. and word Case Presentation recall tests than Case B. Particularly in the late recall task, Case B Case A wordIf recall we consider tasks follow the this language impairment. profile The differences, fact that he Case has severe B has This participant is a right-handed 51 years old female patient, greater deficits in classical linguistic tasks. Working memory and who had 6 years of formal education. She suffered an ischemic for a rupture of the phonological output lexicon. Performance stroke a year from the time she took this evaluation and started onanomia the recognition in spontaneous task discourse also speaks as wellfor aas phonological naming deficits retrieval point treatment. After stroke, she started complaining of hearing

rather than a semantic impairment. However, his deficits are difficulties. Her hearing was assessed, but her auditory thresholds rolenot exclusivelyof lexical semantics phonological as an and explanation do include for semantic the severity difficulties of his were well within normal limits. The difficulties presented by this (comprehension problems). This finding does not rule out the wordpatient comprehension demonstrate deficits are preserved in auditory when processing, assessed withby subtests a mild deficit in repeating words and sentences. Naming skills and verbal and working memory deficits. However, it is clear that semantics alone does not explain the low performance of Case B in morphemicof the Boston paraphasia battery. However, occurrences, phrase while comprehension episodes of neologism is mildly Althoughthe memory less tasks. severe, Case her A showsverbal clearlymemory a picture and working of phonological memory andimpaired. anomia Her are spontaneousalso observed. discourse Semantic isparaphasia rich in phonemic is not present and auditory deficits which cannot be related to semantic impairment. in the discourse context, neither does it appear in formal testing. the neuropsychological functions. Thus, it seems plausible to difficulties also contrast with the preservation of the rest of

Language profiles were obtained in both cases with the Boston hypothesize that Case A’s phonological impairments alone may Battery [10]. The neuropsychological profile obtained through relate to her word recall and working memory deficits. Neupsilin-Af shows impaired working memory, as well as deficits

Citation:

Grigol CL, Bauer MA, Brandão L (2017) Expressive Aphasia: Reporting a Phonological Retrieval Hypothesis for Auditory Verbal Memory Deficits. J Neurol Stroke 7(3): 00241. DOI: 10.15406/jnsk.2017.07.00241 Expressive Aphasia: Reporting a Phonological Retrieval Hypothesis for Auditory Verbal Copyright: 3/4 Memory Deficits ©2017 Grigol et al.

Figure 1:

Cases on Ischemic stroke. Discussion Trojano et al. [12] described a case who could repeat words but

nonwords, so his impairment was related to auditory phonological coding,not nonwords. characterizing He had noa difficultiespicture of inphonemic reading both deafness. words Theand In the last 20 years aphasia research has corroborated to the accessing linguistic representations rather than a loss of linguistic authors concluded with the short-term memory and verbal idea that the problem that characterizes aphasia is a difficulty in learning performance of this case that he had a selective short- aphasiology: researchers are beginning to speak not in terms of term memory defect related to auditory phonological coding as cognitionrepresentations. and language, A paradigm but in terms shift of is the occurring cognitive in requirements the field of of language processing. This paradigm shift implies viewing some wellThe as short-termknowledge memory we havecapacity today limitations about [13].language and access to linguistic representations [5]. communication processing demonstrates that we can no longer of the main aphasic deficits as the result of impairment in the In this context, working memory and auditory-verbal memory implications not only for theoretical models, but especially for are considered as important cognitive functions which possibly establishingseparate language the interdisciplinary and cognition nature fields. Thisof neuropsychology has important take part in language processing. When preserved, these of language and communication in clinical practice. The functions may facilitate the access to linguistic representations. assessment of cognitive skills related to language processing and Word recall may depend not only on memory storage, it may also communication is fundamental for the effectiveness of speech- relate to components required from working memory. The latter language therapy. For a long time many cognitive functions were involves both temporary storage systems and an executive control not classically considered as important in the understanding of device that provides the capacity to actively manipulate stored communication disorders. As science progresses, models are that working memory tasks activate the Broca area [11]. These information. Recently, functional neuroimaging findings show processing.being reviewed As ethics and some and skillsclient (suchcentered as auditory perspectives verbal postulate, memory and working memory) are being directly linked to language findings corroborate with the idea that working memory has a significantA recent role review in the of linguistic the literature system. [5] shows that studies on aphasia and episodic verbal memory have pointed to a close Referencesclinical practice should follow scientific progress [14,15]. 1. Willem JM Levelt impairment of verbal auditory memory. In the present case report, . relationship between the predominance of semantic deficits and (1990) Speaking: From Intention to Articulation. 2. The American Journal of Psychology 103(3): 409-418 we demonstrated that phonological deficits may also relate to Nickels L, Stremmer B, Whitaker H (2008) The Hypothesis the verbal and working memory deficits of aphasics. Our report testing approach to the assessment of language. The Handbook of is not alone in this framework. Almost twenty five years ago, Neuroscience of Language 13-22.

Citation:

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